Bevacizumab (Avastin®)

Bevacizumab, which is also known as Avastin ®, may be used to treat people with bowel|, breast| or kidney| cancer, and people with non-small cell lung| cancer. Bevacizumab may also be used to treat other types of cancer as part of a research trial.

You'll see your doctor regularly while you have this treatment so they can monitor its effects. This information should help you discuss any queries about your treatment and its side effects with your doctor or specialist nurse.

Bevacizumab belongs to a group of cancer drugs known as monoclonal antibodies|. Monoclonal antibodies are sometimes called targeted therapies because they work by ‘targeting’ specific proteins on the surface of cells.

Bevacizumab targets a protein called vascular endothelial growth factor (VEGF). This is a protein that helps cancer cells develop a new blood supply. Bevacizumab blocks the protein and stops the cancer from developing new blood vessels. This reduces its supply of oxygen and nutrients so the tumour shrinks or stops growing. Drugs that interfere with blood vessel growth are called angiogenesis inhibitors or anti-angiogenics.

Bevacizumab is licensed to treat some types of cancer that have spread from where they first started (advanced or metastatic cancers). It may be used to treat advanced non-small cell lung cancer or advanced cancers of the bowel, breast or kidney.

The National Institute for Health and Clinical Excellence (NICE|) gives advice on which new drugs or treatments should be available on the NHS in England and Wales. The Scottish Medicines Consortium (SMC) makes recommendations on the use of new drugs within the NHS in Scotland. Neither NICE nor the SMC have recommended the use of bevacizumab. As a result, bevacizumab may not be widely available on the NHS, although you may be given it as part of a clinical trial.

If you live in Northern Ireland, speak to your cancer specialist about whether bevacizumab is recommended to treat your type of cancer.

We have more information about what you can do if a treatment isn't available.

Bevacizumab may be given in combination with chemotherapy| drugs or when interferon| is used to treat kidney cancer.

Bevacizumab is given as a drip into a vein (intravenous infusion). It's usually given once every two or three weeks, depending on the type of cancer you have. The first infusion is given slowly over 90 minutes. If you don’t have a reaction to the infusion, the second infusion will be given over 60 minutes. After this, the infusions usually take 30 minutes, as long as you haven’t had any infusion reactions.

Bevacizumab is usually given for as long as it keeps the cancer under control or until side effects become too troublesome.

Each person’s reaction to cancer treatment is different. Some people have very few side effects while others may experience more. The side effects described here won't affect everyone who has bevacizumab.

Bevacizumab is often used in combination with chemotherapy, so you may also have side effects from the chemotherapy. The side effects mentioned here are those caused by bevacizumab.

We've outlined the most common side effects but haven't included those that are rare and therefore unlikely to affect you. If you notice any effects that aren't listed here, discuss them with your doctor or nurse.

Side effects of bevacizumab fall into two groups:

infusion-related reactions, which are side effects that may occur during the infusion or for up to 24 hours afterwards

other side effects that may occur days or weeks later.

Infusion-related reactions

These are uncommon and affect fewer than 5% of people (5 in 100) having bevacizumab. If reactions occur, they are usually mild, but rarely, they can be more severe.

Reactions are most likely to happen with the first or second infusion, so these infusions are given more slowly to reduce the chance of a reaction. If you have a reaction, this can usually be treated by stopping the drip until you feel better.

You’ll be monitored closely during your treatment, but tell your nurse or doctor if you feel unwell or have any of the following symptoms:

flu-like symptoms, such as feeling flushed, having a fever, chills, or dizziness

red, warm and itchy bumps on the skin (like nettle rash)

a feeling of swelling in the lips, tongue or throat

breathlessness, wheezing, a cough or sudden difficulty breathing

pain in your back or stomach

a tight chest or chest pain.

Rarely, an infusion-related reaction can happen a few hours after treatment. If you develop these symptoms or feel unwell after you get home, contact the hospital straight away for advice.

Other side effects of bevacizumab

Feeling sick (nausea) and being sick (vomiting)

If this happens, it may begin a few hours after treatment is given and last for up to a few days. Your doctor can prescribe anti-sickness (anti-emetic) drugs to prevent or greatly reduce nausea and vomiting.

If the sickness isn't controlled or if it continues, tell your doctor as they can prescribe other anti-sickness drugs that may work better for you. Some anti-sickness drugs can cause constipation. Let your doctor or nurse know if this is a problem.

Tiredness (fatigue) and feeling weak

You may feel tired during and after your treatment. It’s important to try to pace yourself and get as much rest as you need. Try to balance this with taking some gentle exercise, such as short walks, which will help. If tiredness is making you feel sleepy, don’t operate machinery or drive.

Diarrhoea

Bevacizumab can cause diarrhoea. This can usually be easily controlled with medicine but tell your doctor if it's severe or continues. It's important to drink plenty of fluids if you have diarrhoea.

High blood pressure

Bevacizumab can cause an increase in blood pressure in some people. Your blood pressure will be checked regularly during your treatment. If you have headaches, nosebleeds or feel dizzy, let your doctor know. High blood pressure can usually be controlled with tablets prescribed by your doctor.

Headaches

Some people find that bevacizumab causes headaches. Let your doctor or nurse know as they can give you painkillers to relieve this.

Sore mouth and ulcers

Your mouth may become sore or dry, or you may notice small ulcers during this treatment. Some people find that sucking on ice may be soothing. Drinking plenty of fluids, and cleaning your teeth regularly and gently with a soft toothbrush, can help to reduce the risk of this happening. Tell your nurse or doctor if you have any of these problems, as they can prescribe mouthwashes and medicine to prevent or clear mouth infections.

Loss of appetite

Some people lose their appetite while they’re having bevacizumab. This can be mild and may only last a few days. If it doesn’t improve you can ask to see a dietitian or specialist nurse at your hospital. They can give you advice on improving your appetite and keeping to a healthy weight.

Blood clots

You may be at an increased risk of developing a blood clot in your veins or arteries while you're on bevacizumab. Tell your doctor if you or anyone in your family has had problems with blood clotting in the past. Possible blood clot symptoms include:

chest pain

becoming breathless or light-headed

changes in your vision

difficulty speaking or moving

swelling, pain, redness or warmth in an arm or leg.

Contact your doctor straight away if you have any of these symptoms, as you may need urgent treatment. Blood clots are treated with medicine to thin your blood, dissolve any blood clots and stop more clots from developing.

Slow wound healing

Wounds may take longer to heal while you're being treated with bevacizumab. If you have any surgery planned you should stop taking bevacizumab for four weeks before the operation and not start taking it again until four weeks afterwards, as long as the wound is fully healed.

Constipation

You may get constipated. This can usually be helped by drinking plenty of fluids, eating more fibre in your diet and doing some gentle exercise. You may need to take medicine to help (laxative). Your doctor can prescribe these or you can buy them at a pharmacy.

Bleeding

Bevacizumab may cause bleeding problems. Tell your doctor if you take any medicines that may affect bleeding, such as aspirin, warfarin or vitamin E.

Contact your doctor straight away if:

you cough up blood

you have any unusual bruising, nosebleeds or bleeding gums

you have unexpected vaginal bleeding

your vomit is bloody or looks like coffee grounds

you have black, tarry stools.

Risk of infection

Bevacizumab can reduce the number of white blood cells, which help to fight infection. White blood cells are produced by the bone marrow. If the number of your white blood cells is low, you will be more prone to infections. A low white blood cell count is called neutropenia. You will have a blood test before each treatment to make sure that your white blood cell numbers have recovered.

Contact your doctor or the hospital straight away if:

your temperature goes above 38˚C (100.4˚F)

you suddenly feel unwell, even if your temperature is normal.

Occasionally, it may be necessary to delay your treatment if your white blood cell levels are low.

Changes in the way your heart works

This is rare. It's most likely to affect people who have heart disease or who've had either radiation to the chest or some types of chemotherapy, such as doxorubicin or epirubicin. Let your doctor know if you have chest pain, difficulty breathing or ankle swelling as these could be signs that bevacizumab is affecting your heart.

Changes in how your kidneys work

Bevacizumab can sometimes affect the kidneys. You may have tests done on samples of your urine and blood to check that your kidneys are working well.

Pain in the area of the tumour

Some people may have pain in the area of the tumour.

It’s important to let your doctor know straight away if you feel unwell or have any severe side effects, even if they’re not mentioned above.

It's important to let your doctor know straight away if you feel unwell or have any severe side effects, even if they're not mentioned above.

Other medicines

Some medicines, including those that you can buy in a shop or chemist, can be harmful to take when you are having bevacizumab. Tell your doctor about any medicines you are taking, including over-the-counter drugs, complementary therapies and herbal drugs.

Contraception

Little is known about the effects of bevacizumab on a developing baby. Therefore, it’s not advisable to become pregnant or father a child while taking this drug.

It’s not known whether bevacizumab is present in semen or vaginal fluids. To protect your partner, it’s safest to either avoid sex or use a barrier form of contraception for about 48 hours after chemotherapy.

Breastfeeding

There is a potential risk that bevacizumab may be present in breast milk, so women are advised not to breastfeed during this treatment and for a few months afterwards.

Non-cancer hospital admission

If you’re admitted to hospital for a reason not related to the cancer, it’s important to tell the doctors and nurses looking after you that you’re having bevacizumab treatment. You should tell them the name of your cancer specialist so that they can ask them for advice.

Emergency contacts

It’s a good idea to know who you should contact if you have any problems or troublesome side effects when you’re at home. During office hours you can contact the clinic or ward where you had your treatment. Your specialist nurse or doctor will tell you who to contact during the evening or at weekends.

Bevacizumab for the treatment of non-small cell lung cancer (TA148). June 2008. National Institute for Health and Clinical Excellence (NICE).

Bevacizumab in combination with capecitabine for the first-line treatment of metastatic breast cancer (TA263). August 2012. National Institute for Health and Clinical Excellence (NICE).

Bevacizumab in combination with a taxane for the first-line treatment of metastatic breast cancer (TA214). February 2011. National Institute for Health and Clinical Excellence (NICE).

Cetuximab, bevacizumab and panitumumab for the treatment of metastatic colorectal cancer after first-line chemotherapy: Cetuximab (monotherapy or combination chemotherapy), bevacizumab (in combination with non-oxaliplatin chemotherapy) and panitumumab (monotherapy) for the treatment of metastatic colorectal cancer after first-line chemotherapy (TA242). January 2012. National Institute for Health and Clinical Excellence (NICE).

With thanks to: Mr Bruce Burnett, Consultant Pharmacist; and the people affected by cancer who reviewed this edition. Reviewing is just one of the ways you could help when you join our Cancer Voices| network.

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Macmillan Cancer Support, registered charity in England and Wales (261017), Scotland (SC039907) and the Isle of Man (604). A company limited by guarantee, registered in England and Wales company number 2400969. Isle of Man company number 4694F. Registered office: 89 Albert Embankment, London SE1 7UQ.